Art and Science of Laboratory Medicine

Friday, August 29, 2014

The patient was a 72-year-old man who had a diagnosis of polycythemia vera in 2010. A JAK2 V617F mutation was positive. Hydroxycarbamide (hydroxyurea) was started at 500 mg and gradually increased to 1250 mg daily. A review of the peripheral blood smear identified 5% circulating blasts, macrocytosis, and marked megaloblastic changes in WBCs. Interestingly, nuclear hypersegmentation was identified in eosinophils (panels A-C), basophils (panels D-F), and neutrophils (panels G-I).

Some 30 percent of all positive hospital blood culture samples are discarded every day because they're "contaminated" — they reflect the presence of skin germs instead of specific disease-causing bacteria.

In the study, the researchers processed the demographic information, hospital records, blood culture results, and date of death of all patients at the Rabin Medical Center with positive blood cultures from 2009-12. They found that out of 2,518 patients, 1,664 blood cultures drawn from 1,124 patients reflected the presence of a common skin contaminant, coagulase-negative staphylococci (CoNS). High overall CoNS resistance predicted high overall resistance of the bacteria causing disease or infection. Most importantly perhaps, highly resistant CoNS isolates were found to be associated with higher short-term mortality.

The researchers hope their conclusions will cause clinicians to pause before discarding contaminated blood test results.

Wednesday, August 27, 2014

The researchers developed a new continuous glucose monitoring material that changes color as glucose levels fluctuate, and the wavelength shift is so precise that doctors and patients may be able to use it for automatic insulin dosing – something not possible using current point measurements like test strips.

Sunday, August 24, 2014

Case: 72 years old female from Greece is in relatively good ccondtion and has no special symptoms to complain. Blood smear was taken during the annual healt check and an example of findings are in the image. Cells like this were counted around 6% of total white blood cells.

Wednesday, August 20, 2014

The aim of the IFCC Task Force for Point of Care Testing is to promote quality in the use, performance, interpretation and reporting of point of care testing across the full spectrum of clinical chemistry and laboratory medicine; to create a forum for high level discussion on a wide range of related topics; and to provide international leadership for developing the clinical practice of POCT in Laboratory Medicine. The PoCT Satellite Meeting held in Istanbul in June 2014 brought together international experts in the field to discuss the concept of PoCT Enabling Patient-Centred Care. Presentations from this meeting are now available for those who were unable to attend this event.

Researchers at Children’s Hospital Los Angeles have shown that a select team of immune-system cells from patients with leukemia can be multiplied in the lab, creating an army of natural killer cells that can be used to destroy the cancer cells. Results of their in vitro study, published August 19 in the journal Leukemia, could one day provide a less toxic and more effective way to battle this cancer in children.

As a way to avoid these adverse effects, investigators have been researching how to supercharge the body’s innate cancer-fighting ability– a technique called immunotherapy. One branch of the immune system – and a possible component of immunotherapy – includes a class of cells called natural killer (NK) cells. These specialized white blood cells police the body and destroy abnormal cells before they turn cancerous.

As with all of the pituitary axises, the thyroid one is a little confusing when people talk about it but really quite simple when it’s drawn out. Free T4 is what normally gets measured to determine if someone is hypo- or hyperthyroid, but if you are just doing a basic screening test, you only need to measure TSH.

Case: 62 years old dairy worker from Denmar has been complaining bone pain and abdominal disconfort for some time. Now she has bruises all over her body and her nose is bleeding very easily.
Basic blood count shows anemia, leukopenia and severe trombocytopenia. Blood smear was taken and the findings are in the image.Can you identify these three particles and what could be the diagnosis?

Saturday, August 16, 2014

Early results have shown the simple test can diagnose cancer and pre-cancerous conditions from the blood of patients with melanoma, colon cancer and lung cancer with a high degree of accuracy. The test centres around damage to white blood cells. The researchers say there is a clear distinction between the damage to the cells or those with or without cancer. The longer the tail, the more DNA damage. And these measurements correlated to those patients who were ultimately diagnosed with cancer (58), those with pre-cancerous conditions (56) and those who were healthy (94).

Friday, August 15, 2014

This is a rare and unique case of AML with the characteristic presence of Auer rods in myeloblast and dysplastic granulocyte in association with loss of the Y chromosome. The loss of the Y chromosome is widely reported in myeloid malignancies, whereas presence of Auer rods in mature and dysplastic granulocytes is rare and has been described in AML with maturation. Presence of Auer rods in AML is associated with good prognosis, whereas its significance in dysplastic granulocyte has yet to be determined.

Thursday, August 14, 2014

A cure for a range of blood disorders and immune diseases is in
sight, according to scientists who have unraveled the mystery of stem
cell generation. Found in the bone marrow and in umbilical cord blood,
HSCs are critically important because they can replenish the body's
supply of blood cells. Leukemia patients have been successfully treated
using HSC transplants, but medical experts believe blood stem cells have
the potential to be used more widely.

Wednesday, August 13, 2014

Bacteriophages are viruses that infect bacteria, and in the great war between humans and pathogenic bacteria they can act as allies for both sides. Phages that destroy their host bacteria can be used as antimicrobial therapy, complementing or replacing antibiotics. On the other hand as phages are essentially little capsules that carry DNA from one bacteria to another, they can spread the genes that make bacteria resistant to antibiotics.

The image below shows a stylised drawing of a bacteriophage. The DNA is the swirl contained in the icosahedral head at the top. Bacteriophages work in different ways; some enter their bacterial host and incorporate their genome into the bacterial DNA, happy to settle down and replicate with the host. Others multiply inside the bacteria to create new phage genomes, which then burst out of the host and spread. Other phages incorporate both strategies at different stages in their lifecycle – replicating with the bacteria when times are good, and spreading and destroying the host at any sign of stress.

Breast cancer – the most common type of cancer affecting women – is often thought of as a single disease. However, mounting evidence suggests that there are multiple subtypes, all of which occur at different rates, have varying levels of aggressiveness, and respond to different types of treatment. One of the better understood subtypes is HER2-positive breast cancer, defined by high expression of the HER2 protein. Women with HER2-positive breast cancer are often treated with targeted therapies such as trastuzumab, which has dramatically improved survival rates from HER2-positive breast cancer in the past decade.

Monday, August 11, 2014

The use of modern laboratory instrumentation with high levels of test reliability and appropriate quality assurance measures will lead to very few analytical errors within hemostasis testing. Nevertheless, incorrect or inappropriate test results are still reported, often due to events outside the control of the laboratories performing the tests. This is due primarily to pre-analytical events associated with sample collection and processing, as well as post-analytical events related to the reporting and interpretation of test results. This review focuses on the pre-analytical phase, highlighting contributory elements and providing suggestions on how problems can be minimized or prevented, thereby improving the likelihood that reported test results actually represent the true clinical status of the patient rather than that of an inappropriate sample. This review should be of value to both laboratory personnel and clinicians because an appreciation of these issues will enable the optimal clinical management of patients.

Every lab knows that their colleagues in medicine see turnaround time (TAT) as something almost as important as the quality of test results themselves. In fact, surveys have found that 80% of labs get complaints about TAT. However, TAT can mean much more than just keeping physicians happy.

On the same day patients arrive for a chemotherapy infusion—up to 80 a
day—oncologists routinely order complete blood counts (CBC) and
comprehensive metabolic panels (CPNL) to discern whether the patient is
healthy enough for treatment. Chemotherapy drugs are so toxic that they
can destroy red blood cells and damage the liver and kidneys.

After studying the problem and tracking the exact path of samples, lab team came up with a plan that reduced the median
collection-to-result turnaround time for CBCs from 50 minutes to 20, and
for CPNLs from 74 minutes to 54.

Case: 12 years old male from Florida, US has lost weight and felt himself very weak lately. Now he has abdominal pain and fewer. Stool sample for parasites was taken and the findings are in the image. The size of the particle is 125 x 85 micrometers.

Louis Pasteur was one of the forefathers of microbiology, what he is most know for was his technique of heating liquids such as milk just enough to kill bacteria making it less likely that people would get sick from drinking it. The technique was called pasteurization and is depicted in this image.

Specimencare provides a series of posters giving best practice guidance and education around key aspects of the preanalytical phase of laboratory medicine. These posters are designed to be used by patients and medical professionals.

Friday, August 8, 2014

A team has developed an app and small lens add-on that allows blood-cell analysis via a smartphone.

The team says it can detect diseases such as malaria and cancers in seconds, through so-called predictive cell counting. Users take a picture of their blood using the lens attachment, which is then sent to the app's servers, and the results are then sent back to them.

But experts warned of the difficulty of reproducing the quality of medical labs results using just a smartphone. Also in a laboratory diagnosis, there is a lot of regulation that goes on behind the scenes to make sure that your results are meaningful.

A 61-year-old female patient with an uneventful medical history was admitted to the emergency department because of icterus and abdominal discomfort. Upon arrival, she was hemodynamically stable. No laboratory tests could be performed because of a massive hemolysis, so the decision was made to perform a direct blood smear, which showed 2 species of bacteria and erythrophagocytosis.

Although analyzer-read hCG tests are not intended to detect conditions other than pregnancy, a number of conditions other than pregnancy, including trophoblastic disease and certain non-trophoblastic neoplasms, can cause borderline levels of hCG. Borderline hCG results are in no sense diagnostic, but may, especially when results do not fit a clinical picture, indicate to clinicians that further investigation is needed.

Monday, August 4, 2014

External quality assessment (EQA) with commutable samples is essential for assessing the quality of assays performed by laboratories, particularly when the emphasis is on their standardization status and interchangeability of results.

Smart phone microscopic photography entails using the third through fifth fingers of the left hand to steady the hand on the left microscope eyepiece, holding the camera between the thumb and second finger of the left hand and second through fifth fingers of the right hand, to leave the right thumb free. By looking through the smart phone screen while focusing on the light in the ocular of the right eyepiece and slowly bringing the phone closer to the microscope, the view beneath the microscope lens will eventually fill the screen. The right thumb is free to focus the camera and capture the image. The camera's zoom function can remove vignetting (the circular frame around the image). Additional basic smart phone camera functions can be used to produce high-quality images suitable for use in presentations, posters, and publications. Successful smart phone microscopic photography is dependent on the ability to hold the camera steady and, while initially frustrating to learn, the technique can be readily mastered.

Haemolysis is defined as the release of haemoglobin and other intracellular components from erythrocytes, thrombocytes and leukocytes into the extracellular fluid i.e. the plasma or serum, following damage or disruption of cell membranes. Haemolysed specimen is the most common reason for rejection of specimens in the lab. Studies have shown that out of the total specimens received in the lab, 3.3% are found to be haemolysed, and out of the total rejected; 40-70% has been identified to be due to haemolysis. The American Society of Clinical Pathology has established a 2%, or lower, benchmark for haemolysis rates amongst laboratory blood samples.

Around 600000 - 800000 injuries in every year occur in USA. Half of cases are not reported. Half of all hepatitis B and C in some parts of Africa and Asia are due to contaminated sharps. 2/3 of hepatitis B and C in Eastern Mediterranean are due to contaminated sharps. Over 2/3 of hepatitis B in Central and South American are due to occupational exposure